A Continuous and Noninvasive Method to Estimate Pao/Fio Ratio.

Crit Care Explor

Both authors: Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada.

Published: November 2024

Objectives: To validate a method for continuously estimating the Pao/Fio (PF) ratio in all critically ill pediatric patients using only standard continuous data monitoring.

Design: Retrospective study on a high temporal resolution database.

Setting: PICU in Montreal, QC, Canada.

Patients/subjects: We included any patients admitted from May 2015 to May 2023 who had an arterial blood gas (ABG) with concurrent continuous pulsed oximetry saturation (Spo) values. We used our previously validated mathematical model to determine the magnitude of hypoxemia by computing the estimated ePao/Fio (ePF) ratio and comparing it to the Spo/Fio (SF), using PF ratio as the reference standard.

Interventions: None.

Measurements And Main Results: We analyzed a total of 20,828 ABGs. When Spo was below or equal to 97%, the ePF ratio showed a significantly better hypoxemia classification (none, light/moderate, or severe) than the SF ratio (0.80 vs. 0.72; < 0.001), a lower fixed bias (16.26 vs. -35.24; < 0.001), a lower mean absolute error (37.92 vs. 63.93; < 0.001) and a lower proportional bias (slope of 1.01 vs. 0.81; < 0.001). ePF ratio has also a better limits of agreement difference from Bland-Altman plot (248.10 vs. 292.45; < 0.001) and coefficient of determination (0.68 vs. 0.59; < 0.001). When Spo was above 97%, the ePF ratio had better classification with Kappa (0.53 vs. 0.43; < 0.001) and lower fixed bias (-0.63 vs. 65.68; < 0.001).

Conclusions: The PF ratio based on ePF allows for a continuous estimation of hypoxemia severity with a better performance than the SF ratio.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519398PMC
http://dx.doi.org/10.1097/CCE.0000000000001174DOI Listing

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